Here is one of the most devastating hospital criticisms in Dr. Marty Makary’s new book.  Makary relays the story of Dr. Guy Clifton a Houston neurosurgeon who made an interesting discovery during his attempts to work with his hospital administration to lower the incidence of postoperative surgical complications in his hospital.  ”He (Clifton) learned how the business of medicine works-the reason there was no business case for his plan to lower complications was that hospitals profit from bad medical care.  He realized that hospitals get more money for each complication, X-ray and extra patient day in the ICU.  One well-known national study that was, ironically, released around the time of his departure estimated that a hospital gets paid $10,000 extra per surgical complication.”  

So from a strictly business stance, who does a hospital want to hire when they are out hiring surgeons?  Think they want the best guy with almost no postoperative complications?  Makary’s simple story of Dr. Clifton illustrates a point that I have made repeatedly on this blog, that the doctors that physician-owned facilities kick out and the doctors we facility owners avoid like the plague tend to migrate to the big hospitals where their unethical and/or incompetent behavior is rewarded and welcome.  This is a point that begs to be made at this point in his book but which Makary misses, primarily because he is a salaried doctor in a big multi-specialty clinic.  

Physician-owned facility owners boot bad surgeons because they don’t want to be associated with them professionally for the stain on their own reputation and they don’t want the added liability that these buffoons bring to the facility in which they have ownership.  That these incompetent physicians represent huge sources of revenue for the big hospitals and are welcomed with open arms at these facilities makes sense once you read Dr. Clifton’s story.  This failure to connect all of the dots in Makary’s book is unfortunately a constant annoyance, even though the point he makes is devastating.

Here’s another.  Makary writes,”When choosing a hospital, beware of clever marketing.  When a company wants to sell soda or a designer wants to market its two-hundred dollar blue jeans, they will pump endless amounts of money into advertising campaigns to make their product appealing to consumers.  Hospitals are no different but, unlike choosing a pair of jeans, choosing the wrong health care provider can have permanent consequences.  Don’t be taken in by fancy banners like ‘center,’ ‘top hospital,’ or ‘best docs.’ ”  Insist on finding out how many patients they treat each year for your condition.  Hospitals create ‘centers’ to lure business, but remember, one doctor-or even a few-does not constitute a ‘comprehensive center.’ ”  Patient-satisfaction surveys do not capture quality medical care, and ‘top’ scores and rankings in magazines are often paid for.”

This hard-hitting writing makes the book worth reading.  However, these remarks come at one quarter of the way through the book and he still hasn’t mentioned prices and their role in cleansing the marketplace of frauds and butchers.  He never does.  He never connects his great message of quality transparency with price transparency.  What a missed opportunity.  

G. Keith Smith, M.D.